Tennessee blames feds for TennCare delays

Tennessee blames feds for TennCare delays

August 15th, 2014by Kate Belz in Local Regional News

Accused of creating monthslong delays for thousands of Tennesseans trying to apply for Medicaid, TennCare officials named in a federal lawsuit said Thursday that another name needs to be topping the lawsuit: The federal government.

In a memo filed Thursday evening, attorneys for the state asked a federal judge to dismiss the lawsuit filed against them last month, arguing that the long delays alleged by 11 Tennessee plaintiffs - including new moms, newborns and people with chronic health conditions - are not in their hands.

"In short," state attorneys wrote, "Plaintiffs allege an injury that results directly from the actions or inactions of the [federally-facilitated marketplace]."

Since the beginning of this year, Tennesseans wanting to apply for the state's Medicaid program have been unable to apply through state offices, instead being directed to apply on the federal health exchange HealthCare.gov - a website, health policy experts say, that was never designed or intended to be used for mass Medicaid applications.

The state is directing people to the site because a $35 million computer system that was supposed to start making TennCare eligibility decisions at the start of this year remains unfinished.

The initial lawsuit was filed last month by three legal advocacy groups - the Tennessee Justice Center, the Southern Poverty Law Center and the National Health Law Program - on behalf of 11 people, who include a Soddy-Daisy mother and her newborn - who have waited two and three times the federal limit to learn whether they will be receive Medicaid coverage.

Some have waited as long as six months, while putting off treatments for serious conditions or accruing hefty hospital bills.

But the state said those delays are because of the federal government, which has had problems with its own system transferring applicants' information.

"Without access to the application file, TennCare has no ability to review or understand why the [federally-facilitated marketplace has made or failed to make an eligibility determination," the state wrote.

The attorneys battling TennCare say that the state's latest position was expected.

"The state's position is not a surprise," said Michele Johnson, executive director of the Tennessee Justice Coalition, one of the three legal advocacy groups that are representing the 11 plaintiffs.

"It is of a piece with the state's continued efforts to try to blame everyone else and deny responsibility for the harm to its own citizens and the health system we all rely upon," she said.

Johnson pointed out that two-thirds of the $10 billion program are paid for by the federal government, which entrusts the state with its administration.

"Are they [the state] going to give that back?" Johnson said.

The state further argued that the delays, though not the state's fault, do not violate federal law because the law gives an exception to normal time limits in unusual circumstances, and "the operational problems experienced by the federal exchange qualify for the exception," attorneys wrote.

U.S. District Judge Todd Campbell of Nashville has set a hearing for Aug. 29 to decide whether the lawsuit against the Medicaid agency will take on class-action status.

The hearing will also determine whether the plaintiffs - and potentially hundreds of other Tennesseans - will get quicker access coverage or if they will have to wait for the lawsuit's resolution, which could take months.

The state argued in their response that the lawsuit should not be a class-action, citing that the civil rights attorneys "have produced no evidence supporting their assertion that a 'substantial' number of individuals" have not received timely eligibility, and that the assertion that hundreds or thousands of people have fallen through the cracks is "bare speculation."

The Tennessee Justice Center says they continue to be flooded with calls from people looking for answers about TennCare coverage they have been trying to obtain for months.